Presentation on theme: "Flouro Images of Lumbar Spine Injections"— Presentation transcript:
1Flouro Images of Lumbar Spine Injections David F. Drake, MDDirector, VCU PM&R Pain FellowshipDavid Berkower, MDPain Fellow
2Using Contrast DyeThe following views were obtained using an injection dummy and therefore no contrast dye was used.We recommend, when available, the use of contract dye to confirm needle placement
3Lumbar Median Branch Block (MBB) The flouro is placedin the oblique positionat approx 30 degreesto view the “scotty dog”.The needle is directed atthe eye of the “scottydog” and advanced untilbone is contacted.Needle
4Lumbar Facet Injection A lumbar facet injection would be done in a similar fashion as a MBB, however the target is the facet joint (between the ear of the lower “scotty dog” and the front foot of the upper “scotty dog”).
5Sacroiliac Injection The flouro is placed just off AP in order to align the inferior polesof the SIJ. The needleis advanced into theinferior poles until aloss of resistance isappreciated.Needle
6AP View of Lateral Hip Injection The lateral hip approach avoids the nerves and vessels which may be encountered in the anterior approach. It’s wise to get a lateral flouro view to confirm needle placement.
7AP View of Anterior Hip Injection When performing a hipinjection from the anterior,the artery should be palpatedat all times and gentlenegative pressure (aspiration)in the syringe is important toavoid intravascular injection.
8AP View of Anterior Hip Injection – Part 2 A different view
9Oblique View of Lumbar Transforaminal Epidural Place the flouro in the oblique position (approx 30 deg). Focus the needle under the chin of the “scotty dog” [superior aspect of lateral foramen].Needle
10Lateral View of Lumbar Transforaminal Obtain a lateral view toconfirm needle is w/inthe foramen.
11AP View of Lumbar Transforaminal Finally, obtain an AP viewTo confirm the needle isMedial enough and w/in theEpidural space.*Note: for a selective spinalnerve injection the needleshould be more lateral andnot w/in the epidural space.
12Oblique View of Disc Injection The flouro is placed in theoblique position [approx30 deg]. The needle isadvanced into the discspace. A firm, fibroussensation is often felt whenentering the disc.
13Lateral View of Disc Injection A lateral flouro view isobtained to confirmneedle depth.
14AP View of Disc Injection An AP view may be obtained to assess how medial the needle is.
15Oblique Lumbar Sympathetic Block An oblique flouro view[approx 30 deg] is obtained.The needle is directed justanterior to the L-3 vertebral body.Needle